A client who is receiving pregabalin for fibromyalgia reports experiencing tremors in the hands. Which action should the nurse implement?

A) Notify the healthcare provider of the passage of black stools: This is the correct response. Black stools can indicate gastrointestinal bleeding, which is a serious adverse effect of NSAID use. It's im’ortant for the client to report this symptom promptly to the healthcare provider for further evaluation and management.

B) Call the clinic if diarrhea or headache occur when taking esomeprazole: While it's im’ortant to report any adverse effects of medication to the healthcare provider, diarrhea and headache are not specific to esomeprazole and may not warrant immediate attention unless severe or persistent.

C) Once pain subsides, NSAID therapy can be resumed: This statement is incorrect. The client should avoid NSAIDs in the future, as they are likely the cause of the gastric pain and gastrointestinal bleeding. Resuming NSAID therapy would increase the risk of recurrent bleeding.

D) Resume a diet that consists of milk, cream, and bland foods: This statement is incorrect. While bland foods may be easier to tolerate during acute gastric pain, they do not address the underlying issue of gastrointestinal bleeding. Additionally, dairy products like milk and cream may exacerbate symptoms in some individuals.

A) Asking the client to describe how she takes the medication is the most appropriate initial response by the nurse. “Heartburn” reported after taking risedronate raises concerns about potential esophageal irritation or gastroesophageal reflux disease (GERD) exacerbation. Understanding the client’s administration technique (e.g., whether she takes the medication with a full glass of water and remains upright for at least 30 minutes afterward) can help identify potential causes of the reported symptoms.

B) While suggesting the use of an antacid two hours after the medication may provide symptomatic relief, it does not address the underlying issue of potential esophageal irritation or GERD exacerbation related to risedronate administration. Moreover, if the client’s symptoms are due to esophageal irritation, using an antacid may mask the symptoms without addressing the cause.

C) Reminding the client to take the medication with plenty of water is a standard recommendation for bisphosphonate administration to minimize the risk of esophageal irritation and ensure proper drug absorption. However, since the client is already experiencing “heartburn,” further assessment of the client’s medication administration technique is warranted before providing this reminder.

D) Advising the client to go to the nearest emergency department is not appropriate at this stage, as the reported symptom of “heartburn” does not suggest an immediate life-threatening emergency. However, if the client experiences severe chest pain, difficulty swallowing, or signs of a severe allergic reaction (e.g., swelling of the face or throat, difficulty breathing), emergency medical attention would be necessary.

Therefore, the nurse should first assess the client’s medication administration technique to determine if improper administration may be contributing to the reported symptoms. Based on this assessment, appropriate interventions can be provided to address potential esophageal irritation or GERD exacerbation.